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Friday, December 14, 2012

Guest post: Compartmentalizing work

I watched a child die. Literally. Took his last
breath in front of me. It wasn't an unexpected death, but nonetheless, still very sad. What do you say when
your partner says "How was your day at the office honey"? What do you
say? How many of you share your bad days with your spouse? If you
don't, how do you assimilate what you deal with into your life? Life
went on that day, as it has to, after his death. Yet, I couldn't help but
think the universe should have stopped in some way, briefly, to mark his
passing. A leaf should fall, or the world should go quiet for 60
seconds. We lost a child. Our community lost a child. We lost the
promise of his life, the contribution he could have made to our
society. What would his life have looked like? The impact of watching
life slip away was huge, on all the staff, as well as the family. I
found myself wondering, watching his mom stroking his arm just before he died, how do you comprehend that this evening, your child will
not be with you? That your family will go from 5 to 4. How do you tell his siblings that he died? I watched my
colleague go straight from his death to a mundane meeting, wondering how
is it that life goes on after this little boy has just died? I know
it must, as mine did, and I know that the family's loss is not mine. My
children are safe and well. So, my question is, how much do you share with your
partner and your friends? Do you have people in your life that you can
share your sadness with, or do you have to deal with this on your own?
Not being able to debrief because you need to protect others is a lonely
business. Are we destined to cope alone, because we chose this path?

Jess

Bio
- I live in the South, currently working part time in pediatrics. I am happily
married, with two healthy gorgeous babes. I stumbled across MIM a few months ago and have been following it
avidly since, as it helps me to deal with some of the issues I face,
being a working mother in medicine.

I talk to my husband about the things I experience (HIPPA be damned but I speak in stories not names), I'm not sure he appreciates it but sometimes I need to off load so that I can move on. He will admit that on days when I don't volunteer how my day went he doesn't ask for fear that I relive it and my BP goes up --- usually it is administrative or military frustrations or fibromyalgia type things though and not death type things.

I don't think that the death of a child, or adult for that matter, will ever or should ever be so common place that it doesn't cause you to think about your family...... I've never had a child die on my watch, I'm an FP who did residency and now work in a community hospital, but I have delivered 16-22 week pregnancies and I've cried with the mothers for the loss of their child and their dreams, I've told a husband that his wife coded unexpectedly and died, etc.... these moments happen and the human experience cannot be separated from the professional in my opinion. On the flip side, if you are experiencing depression/ptsd/anxiety about such things we as professionals need to be aware enough of ourselves and coworkers to seek or help guide towards help.

You are not at all destined to cope alone! The deaths (and lives) of your patients are a part of you, and you carry that with you no matter what setting you're in.

There are counselors who specialize specifically in caring for caregivers. Maybe he or she could help you find ways to express yourself in a way that honors your patients' privacy, and also help you find a person in your life in whom you can confide. Do you journal?

Anyways, I just wanted to say you are not alone! We all deal with these kind of situations, and to me, it seems like the ones who deal most successfully are the ones who take (a lot of) time for introspection and make good use of their social supports.

Thank you scrubmama - I feel comforted by your words. I had forgotten how helpful journalling can be, and I plan to start again. I also think it will be a lovely way for me to honour each child who touches my life in this way.

"Yet, I couldn't help but think the universe should have stopped in some way, briefly, to mark his passing. A leaf should fall, or the world should go quiet for 60 seconds."

I feel just like this when a patient dies. I am on an Oncology service and in the past week we had 3 people pass. It is incredibly hard for me to just go on with the day as if nothing had happened, but on a busy service it's impossible to do what I want and go to some secluded corner of the hospital and cry. I definitely debrief with my husband at the end of the day when something like this happens, and it absolutely feels better to share the grief with someone and take time to deal with it. I wish there was an outlet in medicine to allow people to decompress somehow and talk about these things, but I've found nothing yet.

Your comments really have helped me. I've been worrying that I'm doing the wrong thing in debriefing with my husband, after two colleagues told me they go home and say nothing to their partners, and I should 'be careful' in talking to mine, for fear of burdening him. That's the last thing I'd want to do, and I've checked in with him to make sure he's ok with it. He has a really neat way of being able to listen to me without taking on board the grief, because he doesn't know the people involved and wasn't there to see it happen. I don't know how to come home after a day like that, and not share how I'm feeling with him. I do protect my non-medical friends from my work, and even my medical friends don't want to know, because of the pediatric aspect. I do find it isolating in that way, and you've helped me to process that experience, so thank you so very much for your replies. In writing this piece, I've been reminded of how journalling can help - I will definitely start again! PS I removed my comment below and pasted it here, because I didn't know to use the Reply button before. I'm new to this!

Thanks for this post. When I was a pediatric resident and med student in NYC, I had a 2 block walk from hospital/school to my apartment. But now (as a MiM) living and practicing pediatrics in the DC region I have a commute. Although commutes are not typically regarded favorably, it is my time to transition, with my reflections, my radio, sometimes my phone conversations.

In addition, as a medical educator, together with colleagues I create time and space to reflect with and among the medical students.

I am so glad to hear you and your colleagues support the junior staff/medical students in this way. I so wish my hospital had something similar, and it's heartwarming to hear that it's not necessarily representative of what's out there. It's something I wish to be involved in, when I'm in a position to do so.

What a coincidence, this post and the current horrors in the news. I have had so many tears in the last 24 hours and your post brought new ones to my eyes. You write beautifully of such a heart-wrenching moment - it made me feel like I was there. I never watched a child die, but I did do child autopsies. I remember my husband at the time, to whom I tried to vent, asked me to stop after a while. He said it was too much for him, and I kind of got it. Sought solace in co-workers instead, and it helped. I don't think we are equipped to cope alone.

I am a doctor working as an hospitalist at Internal Medicine department. I think that being a doctor can be the most lonesome job in the world - no one else understands what we go through when a patient dies with us. I am not a pediatrician because of that, I could not cope with the emotional side of the sickness and dead of a child. Couselling for caregivers? it doesn´t exist in my country. We stik together as a team with colleagues and nurses and that´s all.~maria, mother of 3, Portugal.

Mothers in Medicine is a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding. We are on call every. single. day.

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